Objective To analyze the clinical efficacy of daily online cone-beam computed tomography (CBCT)-guided stereotactic body radiation therapy (SBRT) for primary and metastatic lung cancer and its related factors.Methods From May 2009 to May 2013,36 patients with lung cancer were treated with SBRT,including 24 patients with primary lung cancer and 12 patients with metastatic lung cancer.The biologically effective dose at 10 Gy was ≥ 100 Gy in 85.7％ of 42 lesions.Before each delivery,CBCT was acquired,and online automatic or manual registration was performed to make the tumors on CBCT within the planning target volume/primary gross tumor volume;the setup threshold was not set,and the couch was moved for correction.Results The 1-,2-,and 3-year sample sizes were 36,29,and 26,respectively.The 1-,2-,and 3-year local control (LC) rates were 96％,89％,and 72％,respectively.The 1-,2-,and 3-year cancer-specific survival (CCS) rates were 82％,74％,and 64％,respectively.The 1-,2-,and 3-year overall survival (OS) rates were 78％,64％,and 53％,respectively.Univariate analysis found no factors associated with LC.Multivariate analysis revealed no factors associated with OS.Both univariate and multivariate analyses showed that only tumor location (central type or peripheral type) was associated with CCS;the mean values (95％ confidence intervals) of CCS in patients with central-type and peripheral-type lesions were 21.4 months (13.2-29.6 months) and 42.3 months (35.7-49.0months),respectively (P=0.024).Conclusions Daily online image-guided SBRT for primary or metastatic lung cancer can lead to a satisfactory LC.

Objective To explore a method of using a computer system for multi-media cases study in radiation oncology clinical work,in order to replace the traditional use of film images and paper.Methods We use a dedicated networked computer's Windows XP's Remote Desktop feature to remote access an Eclipse TPS and the radiation therapy information management system.Then we can online read the patient' s information of CT images,target volumes,treatment plans,plan application forms and electronic medical records,and use a projector to project it on the screen.Results There has been half a year since we successfully set up a radiation therapy case study multi-media system in the department.It's convenient and effective to achieve the department conducted a collective case discussion.Conclusions The equipment required is simple,and it's a safe and reliable technology,greatly improving the clinical efficiency and quality of medical care.

Objective To evaluate the efficacy and tolerance of preoperative concurrent chemoradiotherapy in the treatment of locally advanced middle-low rectal cancer.Methods From June 2007 to June 2013,51 untreated patients with histopathologically proven rectal cancer (T3/T4 or N (+))were included in this study.Three-dimensional radiotherapy was delivered to the whole pelvic cavity at 45.0-50.4 Gy/25-28 fractions.Two cycles of chemotherapy with FOLFOX4 or XELOX were given concurrently at weeks 1 and 4 of radiotherapy.Surgery was performed at 4-8 weeks after chemoradiotherapy.Adjuvant chemotherapy with FOLFOX4 or XELOX was given within one month after surgery.The Kaplan-Meier method was used to calculate survival rates,and the log-rank test was used for univariate analysis;the Cox regression model was used for multivariate prognostic analysis.Results Fortynine patients completed the preoperative chemoradiotherapy and surgery.The median follow-up was 2.9 years.The overall sphincter preservation rate was 65％;the overall downstaging rate was 59％.Ten (20.4％) of all patients achieved a pathologic complete response (pCR).Grade ≥3 toxicities occurred in 25％ of all patients,and the overall postoperative complication rate was 31％.The 3-and 5-year sample sizes were 24,12,respectively.The 3-and 5-year overall survival rates were 81％ and 69％,respectively;the 3-and 5-year disease-free survival (DFS) rates were 76％ and 60％,respectively;the 3-and 5-year local recurrence-free survival (LRFS) rates were 78％ and 70％,respectively;the distant metastasis-free survival rates were 82％ and 74％,respectively.The multivariate analysis showed that tumor downstaging was an independent prognostic factor for 5-year DFS and LRFS.Conclusions For locally advanced middle-low rectal cancer,preoperative radiotherapy with concurrent FOLFOX4/XELOX chemotherapy can increase pathologic downstaging rate,pCR rate,and sphincter preservation rate.Patients with tumor downstaging may have a better survival advantage.

Objective To meet the special needs of the department of radiation oncology, a radiation therapy information management system ( RTIMS) has been developed as a secondary database system to supplement the Varian Varis/Aria since 2007. Methods The RTIMS server was used to run a database and web service of Apache + PHP + MySQL. The RTIMS sever's web service could be visited with Internet Explorer (IE) to input, search, count, and print informations from about 30 workstations and 20 personal computers. As some workstations were installed with Windows and IE in English only, some functions had English version. Results In past five years, as the RTIMS was implemented in the department, some further needs were met and more practical functions were developed. And now the RTIMS almost covered the whole workflow of radiation therapy ( RT) . By September 2011 , recorded patients data in the RTIMS is as follows: 3900 patients, 2600 0utpatient RT records, 6800 progress notes, 1900 RT summaries, 6700 charge records, 83000 workload records, 3900 plan application forms, 1600 ICRT records. etc. Conclusions The RTIMS hased on the workflow of RT has been successfully developed and clinically implemented. And it was demonstrated to be user-friendly and was proven to　significantly improve the efficiency of the department. Since it is an in-house developed system, more functions can be added or modified to further enhance its potentials in research and clinical practice.

Objective To evaluate the prognosis and side-effects of three-dimensional conformal radiotherapy (3 DCRT) and intensity modulated radiotherapy (IMRT) for prostate carcinoma. Methods From 2001 to 2009, 62 patients with prostate carcinoma treated with radiotherapy were included in the retrospective analysis. Among them, 60 patients received IMRT while the other two received 3DCRT. There were 56 patients receiving androgen deprivation therapy before radiotherapy. The median dose was 78 Gy to 95% planning target volume (PTV) of the prostate and seminal vesicles, and the median dose to 95% PTV of the pelvic lymph nodes was 48 Gy. Results The median follow-up was 15.4 months. The 3-and 5-year overall survival (OS) rates were 92% and 83%, with the corresponding biochemical disease-free survival rates of 87% and 69%, and the distant metastasis-free survival (DMFS) rate of 77% and 55%, respectively. Patients with a PSA nadir ≤ 2 ng/ml had a 3-year OS of 94% and DMFS of 88%, compared with 56% and 11% (χ~2 = 16. 39, P < 0.01 for OS ; χ~2 = 28. 87, P < 0. 01 for DMFS) for those with a PSA nadir > 2 ng/ml. The incidence of grade 1 and 2 urinary toxicity was 32% and 0% for acute damage, 10% and 0% for late damage, respectively. The incidence of grade 1 and 2 intestinal toxicity was 19% and 3%. for acute damage, 5% and 3% for late damage, respectively. Conclusions Radiation therapy for patients with prostate carcinoma shows satisfactory outcomes with a good toleration. Monitor of PSA after radiotherapy has benefit for prognosis evaluation.

Objective To restrospectively investigate clinical outcomes and prognositic factors in localized prostate cancer treated with neoadjuvant endocrine therapy followed by intensity modulated radiotherapy (IMRT). Methods Between March 2003 and October 2008, 54 localized prostate cancer treated by IMRT were recruited. All patients had received endocrine therapy before IMRT. The endocrine therapy included surgical castration or medical castration in combination with antiandrogens. The target of IMRT was the prostate and seminal vesicles with or without pelvis. The biochemical failure was defined according to the phoenix definition. By using the risk grouping standard proposed by D'Amico, patients were divided into three groups: low-risk group (n = 5), intermediate-risk group (n = 12), and high-risk group (n = 37). Kaplan-Meier method was used to calculate the overall survival rate. Prognostic factors were analyzed by univariate and multiple Cox regression analysis. Results The follow-up rate was 98%. The number of patients under follow-up was 39 at 3 years and 25 at 5 years. Potential prognostic factors, including risk groups, mode of endocrine therapy, time of endocrine therapy, phoenix grouping before IMRT, the prostate specific antigen doubling time (PSADT) before radiotherapy, PSA value before IMRT, interval of endocrine therapy and IMRT, irradiation region, and irradiation dose were analyzed by survival analysis. In univariate analysis, time of endocrine therapy (75 % vs 95 %, χ~2= 6. 45, P = 0. 011), phoenix grouping before IMRT (87% vs 96%, χ~2 = 4. 36, P = 0. 037), interval of endocrine therapy and IMRT (80% vs 95% ,χ~2= 11.60,P= 0. 001) ,irradiationdose(75% vs 91% ,χ~2=5.92,P= 0. 015) were statisticallysignificant prognostic factors for3 - year overall survival , and risk groups (85 vs 53 vs 29 , χ~2= 6. 40,P =0. 041) and PSADT before IMRT (62 vs 120, U =24. 50,P =0. 003) were significant factors for the median survival time. In the multiple Cox regression model, only time of endocrine therapy and phoenix grouping before IMRT were significantly related to the overall survival. The 3-year overall survival rates in patients with endocrine therapy less than 3 months versus more than 3 months were 75% versus 95% (χ~2= 5.45, P= 0.020). The 5-year overall survival rates in patients with biochemical failure versus nobiochemieal failure was 71% versus 92% (χ~2= 8.83 , P= 0.003) Conclusions Neoadjuvant endocrine therapy should last at least three months. Intensity modulate radiotherapy should start before biochemical failure after the endocrine therapy.

In this paper, duloxetine was chosen as the lead compound. The pharmacophores with 5-HT(1A) antagonism activity were used to replace the naphthyl of duloxetine. A series of duloxetine derivatives had been designed and synthesized and whose structures were confirmed with elemental analysis, MS and H NMR. All synthesized compounds were tested by tail suspension test and forced swimming test in vivo. The test results revealed that most of the compounds have shown better activity than duloxetine at the same dosage. Some of them are worth to be studied further.

Objective To investigate the operation technique, feasibility and clinical outcome of endoscopic clearance of axillary lymph node with liposuction(E-ALNC) in 32 patients with breast cancer. Methods From January 2005 to December 2008, a total of 32 patients with breast cancer were treated with E-ALNC.The clinical data of the patients were analyzed retrospectively and compared with those of 46 patients who have undergone traditional axillary lymph node clearance(T-ALNC)during the same period. Results Both groups were Ⅰ～Ⅱ breast cancer. There were no interim open surgery, massive bleeding, subcutaneous emphysema,fat embolism and other complications in E-ALNC. There was no significant difference between E-ALNC and T-ALNC in lymph number removed(15.5 in E-ALNC) and operation time(80 min in E-ALNC). But there was less bleeding (380ml) and lower postoperation complication rate in E-ALNC. Conclusions The E-ALNC and T-ALNC can have the same effect in the breast conserving surgery.The method makes patients attain a physiological and psychological minimal invasiveness. Besides assuring the quality of axillary lymph node clearance, the method can reduce the occurrence of surgical complication and improve the patients'life quality. E-ALNC can replace the routine surgery and can be carried out in the qualified hospitals.

Objective To investigate the anatomic feature and exposing methods of recurrent laryngeal nerve(RLN) in thyroid surgery. Methods The data of 327 cases of thyroid tumor were analyzed retrospectively. The anatomic feature, injury and prevention of RLN were discussed. Of all the cases, 293 RLNs (242 cases) were anatomically exposed. Results The temporary injury rates of RLN was 1.65% (4/242) in the exposed group and 8.23% (7/85) in the unexposed group with a persistent injury rate of 2.35%(2/85). The differences of temporary injury rates and persistent injury rates between the two groups were statistically significant (P<0.05). 67.23% (197/293) of the RLNs had two branches before entering larynx, 61.09%(179/293) of RLNs were posterior to the inferior thyroid artery and 31.39% (92/293) anterior to the inferior thyroid artery, 4.09% (12/293) passed through the bifurcation of inferior thyroid artery, and 4. 13% (10/293) were not related to the inferior thyroid artery. The incidence of non-recurrent laryngeal nerve (inferior laryngeal nerve) was 0.68% (2/293). Conclusions The anatomic relation of RLN is relatively complicated along its journey. The injury of RLN could be reduced with designed exposal during the thyroid surgery.